Riverside Health

• Independently conducts Medical Record audits following official coding guidelines • Analyzes provider coding and documentation to evaluate risks relating to future payor recovery audits • Uses expertise to apply necessary corrections to ensure compliance with payor rules • Researches payor rules for support and guidance • Works in alliance with RHS Internal Auditing • Analyzes coding related to work queues and reporting concerns • Makes recommendations to resolve denied claims and educate to reduce future denials • Audits coded data to determine opportunities for education • Interacts with and educates coding staff in specialty topics

• Ensures high quality documentation that is thorough, accurate and complete to ensure correct reimbursement capture. • Assigns diagnostic and procedure codes to simple record types up to highly complex record types. • Organizes and prioritizes assigned work to ensure that work is completed within the assigned time frame. • Reviews charts and entire medical records, assigning ICD and CPT code combinations to each data element. • Audits for documentation opportunities and queries clinical staff to fill in any gaps to clarify confusing, incomplete or conflicting information and obtain any needed additional documentation. • Contacts and works with physicians as needed for clarification of details to ensure correct coding. • Accurately utilizes the ICD-10-CM classification system and CPT classification system in assigning diagnostic, procedural and complication codes to all claims while meeting billing requirements of various payers.

• Ensures high quality documentation that is thorough, accurate and complete • Organizes and prioritizes assigned work • Reviews charts and medical records, assigning ICD and CPT code combinations • Audits for documentation opportunities, queries clinical staff • Contacts physicians for clarification of details • Utilizes ICD-10-CM classification system and CPT classification system • Maintains coding accuracy at 90% or better • Complies with standardized coding standards and regulations • Participates in specialty specific coding training

• Assesses clinical documentation through extensive review of the medical record • Interacts with providers, nursing staff, and coding staff to ensure appropriate reimbursement • Conducts post discharge reconciliation for comparative analysis of CDI specialist and final coding • Formulates appropriate clinical documentation clarifications • Works with providers and Advanced Practitioners to improve documentation • Participates in departmental education, training, and orientation sessions • Assists in overall quality and completeness of the health record

• Understand and teach operational and troubleshooting techniques for all primary and supporting Radiology, Cardiology, Imaging, 3rd Party equipment and software programs • Responsible for ensuring stable and effective operating platforms • Maintain relationships with vendors and user groups involved with critical software and hardware installations • Assist in the development and implementation of processes and/or procedures that promote patient safety as well as support financial revenue cycle including identification, analysis, and action plans that support correction of outliers • Ensure compliance with Health Insurance Portability and Accountability Act (HIPAA) guidelines • Provide support for IT project implementations and system upgrades • Work with management team for appropriate and timely corrections to data exchange • Develop detailed action reports to identify trends

• Ensures high quality documentation for correct reimbursement capture • Assigns diagnostic and procedure codes to record types • Audits for documentation opportunities and queries clinical staff • Contacts and works with physicians for clarification • Maintains coding accuracy at 90% or better • Participates in coding training and development of coding policies